Updated Guidelines on Payment Supports for Residential Facility COVID-19 Outbreaks

• By: Angela Westhoff
• On: 02/10/2022 15:28:43
• In: Legislative/Government Affairs

This message provides an update to the message sent on July 1, 2020 regarding payment supports, or “outbreak rates,” for Nursing Facilities (NFs), Intermediate Care Facilities (ICF-IDDs), and Appendices B, C, D, E, and F Private Non-Medical Institutions (PNMIs) that incur or have incurred additional expenses due to a COVID-19 outbreak within their facility. 
 
Maine CDC has updated the definition of a COVID-19 outbreak; per Maine's authority from the Centers for Medicare and Medicaid Services (CMS) to pay outbreak rates, this definition determines when facilities are eligible to receive an outbreak rate from MaineCare. As of January 2, 2022, as outlined in a Maine CDC Health Advisory update, COVID-19 outbreak criteria now vary by facility type. For all facility types eligible under MaineCare for outbreak rate payments, Maine CDC now defines an outbreak of COVID-19 as five or more people who have been in-person at a facility with confirmed or probable COVID-19 within a 14-day period. You can find definitions of confirmed and probable cases on the Maine CDC COVID-19 Maine Data webpage, under “Read Details about the Data.” Maine CDC closes outbreaks 14 days after the last positive test or symptom onset, whichever is later. If a facility has any new cases between 15 and 28 days after the outbreak closes, Maine CDC will reopen the outbreak. 
 
We are aware that some facilities have experienced a delay in receiving information about outbreak start and end dates, which, in some instances, has also delayed the implementation of outbreak rates. We appreciate your patience as the Department has been managing through the surges in cases from the Delta and Omicron variants, and delays in implementing outbreak rates may continue. When the Office of MaineCare Services (OMS) receives information from Maine CDC about outbreak start dates, we will reach out to facilities to provide instructions on how to bill the outbreak rate. When OMS receives information about outbreak end dates, we will reach out to facilities to discuss the end of the outbreak rate. 
 
You can find more information about managing COVID-19 in congregate care facilities in this Maine CDC FAQ. 
 
For questions regarding outbreak rates, please contact Provider Relations Specialist Amanda Lee at Amanda.lee@maine.gov.   
 
Staff contact: awesthoff@mehca.org